Clinical Outcomes of Pharmacological Therapies for Heart Failure in Black vs. White Populations: A Meta-analysis of Randomized Controlled Trials of Heart Failure

Yujia Li¹Huilin Tang¹Wenxi Huang¹Wei-Han Chen¹Shao-Hsuan Chang¹Jiang Bian²Mustafa Ahmed³Stephen Kimmel⁴Jingchuan Guo^1*

• ¹Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States
• ²Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
• ³Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States
• ⁴Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States

Objective: To evaluate the effect of different pharmacological therapies for heart failure (HF)HF between the Black vs. White population.We included RCT randomized controlled trials (RCT) of HF pharmacological therapies with explicit strata of Black or White adults in the primary or secondary analysis. We examined three outcomes: 1) the composite of CV death orand hospitalization for heart failure (HHF), 2) HHF, and 3) all-cause mortalitydeath. Within each race (White and Black), we calculated the pooled risk ratio (RR) with a 95% confidence interval (CI) of different pharmacological therapies using random-effects models. Within each pharmacological therapies, a meta regression was performed towe assess the differences in the treatment effect by race.In 19 RCT reporting eight pharmacological therapies, there was no significant difference between the Black and White groups for using sacubitril/valsartan, angiotensin-converting enzyme inhibitors, calcium-channel blockers, direct renin inhibitors, oral soluble guanylate cyclase, or vasodilators. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) had a different effect in HHF across the White and Black patients (Pinteraction =.030), with a better treatment effect observed in the Black (RR 0.39, 95% CI 0.19 to 0.80) compared to the White group (0.90, 0.71 to 1.14). Betablockers had a better treatment effect in the White (0.65, 0.52 to 0.81) compared to the Black group (1.14, 0.88 to 1.47) regarding the all-cause mortalitdeathy outcome (Pinteraction=.001).